Non-specialists can help with common mental disorders perinatally

By MD Will Boggs

NEW YORK (Reuters Health) - Psychosocial interventions delivered by non-specialists in middle-income countries can benefit women with common mental disorders in the perinatal period, according to a meta-analysis by UK researchers.

"Interventions for perinatal common mental disorders are often delivered by non-mental health specialists," Dr. Kelly Clarke from University College London told Reuters Health by email. "However, our findings suggest they can also be effectively delivered by non-specialists in low-resource settings where psychologists and psychiatrists may be scarce."

"Furthermore, although psychological interventions were associated with greater effects, health promotion interventions that are less focused on mental health may also be beneficial," Dr. Clarke said.

In low- and lower-middle-income countries, common mental disorders--depressive, anxiety, and somatic disorders--affect an estimated 16% of women during pregnancy and 20% of women in the postnatal period.

Dr. Clarke and colleagues conducted a systematic review and meta-analysis of interventions for these disorders in low- and middle-income countries, with a focus on psychosocial interventions delivered by providers without specialized mental health training in community and primary care settings.

Their search uncovered 11 trials, none of which were conducted in low-income countries. Seven were conducted in upper middle-income countries, and four were conducted in lower middle-income countries, the authors reported online October 29th in PLoS Medicine.

Interventions delivered by non-specialists resulted in a reduction in mental disorder symptoms and "caseness" immediately after the intervention, with an effect size of 0.34 for symptoms and a 41% reduction in caseness (i.e., in the proportion of patients with the disorder of interest).

Health promotion interventions for the mental disorders were beneficial compared with usual care, although psychological interventions showed a significantly greater benefit.

Two components common to health promotion interventions included (1) sharing information and developing skills to enhance perinatal health and (2) giving women an opportunity to share concerns and feelings and receive social support in the context of a group or individually.

Individual and group interventions were equally effective, whereas interventions that combined group and individual components were not significantly better than usual care.

Interventions delivered during pregnancy and postnatally were significantly better than usual care, but interventions delivered only during pregnancy were not significantly different from usual care.

"There is a dearth of trials from low-income countries, and research to assess the feasibility and effectiveness of delivering psychosocial interventions for perinatal common mental disorders in these countries is urgently needed," Dr. Clarke concluded.


PLoS Medicine 2013.

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